Umbilical Hernia

Excerpt

The European Hernia Society defines umbilical hernias as ventral abdominal hernias located within 3 cm above or below the umbilicus. They account for 6% to 14% of all adult abdominal wall hernias and are second in frequency only to inguinal hernias. In infants, umbilical hernias occur in 10% to 15% of cases and often resolve spontaneously by age 2. Umbilical hernias that persist beyond age 5 or measure more than 1.5 cm in diameter may require surgical repair. This activity focuses exclusively on umbilical hernias in adults. Please refer to StatPearls' companion resource, "Pediatric Umbilical Hernia," for the evaluation and management of umbilical hernias in children.

The European and American Hernia Societies classify adult umbilical hernias by size: small (<1 cm), medium (1–4 cm), and large (>4 cm) in diameter. The hernia sac typically contains preperitoneal fat or omentum but may also include a portion of the small intestine or, less commonly, the colon.

Many individuals are diagnosed with an umbilical hernia during routine physical examinations. If the hernia is asymptomatic, expectant management is often preferred over surgical repair. However, 65% of adult patients with an umbilical hernia eventually require surgery, with 3% to 5% of these cases needing emergency intervention. Individuals with asymptomatic hernias should be counseled on the signs and symptoms of incarceration and strangulation and advised on safe lifting techniques.

Surgical repair of an umbilical hernia is indicated in cases of pain, functional impairment, or hernia enlargement. The choice of surgical approach depends on the size of the hernia and patient-specific factors, including comorbidities, body mass index, and the presence of other abdominal wall hernias. Elective repairs may be performed under local anesthesia with sedation or general anesthesia, while urgent surgery typically requires general anesthesia.